Liver Biopsy can be Safely Performed in Pediatric Acute Liver Failure to Aid in Diagnosis and Management

Objectives: Liver biopsy can be a valuable tool to help determine the etiology of pediatric acute liver failure (PALF), but is often not performed due to safety concerns. The primary aim was to describe the incidence of major complications after liver biopsy performed in the setting of PALF. Methods: Medical records from 2006–2016 were reviewed. Patients age 0–17 years, who met criteria for PALF, and had a liver biopsy performed while their international normalized ratio (INR) was ≥1.5 were included. Results: 26 cases of liver biopsy in the setting of PALF were identified. The majority (n = 22, 85%) of patients had primary liver disease. Most biopsies (n = 17, 65%) were performed by the transjugular route, with 5 (19%) performed percutaneously under ultrasound guidance and 4 (15%) during a surgical procedure. Median INR prior to biopsy was 2.1 (IQR = 1.73–2.9). Blood products were given prior to or during the procedure in 23 (88%) cases. One patient (3.8%) had a major complication of biopsy-associated bleeding requiring a blood transfusion. An additional 3 patients had a hemoglobin decrease of 2.1–2.9 g/dL post-biopsy that was attributed to the procedure but no interventions were necessary. Biopsy results contributed to establishing a diagnosis in 62% (n = 16) of cases, and influenced treatment decisions in 9 of those cases. Conclusions: Liver biopsy is safe in the majority of patients with PALF and associated with infrequent major complications. Clinicians should consider performing liver biopsy in this setting, especially when the transjugular approach is feasible, since findings may guide diagnosis and therapy. Address correspondence and reprint requests to Catherine A. Chapin, MD, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 65, Chicago, IL 60610 (E-mail cchapin@luriechildrens.org). Received 10 January, 2018 Accepted 22 June, 2018 Author contributions: Catherine A Chapin, MD and Estella M Alonso, MD were involved in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the initial manuscript; critical revision of the manuscript for important intellectual content; and study supervision. Saeed Mohammad, MD, Sarah A Taylor, MD, Lee M Bass, MD, and Susan Kelly, RN were involved in study concept and design; analysis and interpretation of data; and critical revision of the manuscript. Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to disclose. There are no sources of funding to declare for this work. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2zXVjSA
via IFTTT